I Shall Not Hate: A Gaza Doctor's Journey (16 page)
Read I Shall Not Hate: A Gaza Doctor's Journey Online
Authors: Izzeldin Abuelaish
Tags: #Biography & Autobiography, #Personal Memoirs, #History, #Middle East, #General
The previous December I had been invited to the Third National Conference on Health Policy in Jerusalem. Getting there had been the usual trial, but chasing after the permits and exercising patience turned out to be worth the trouble: at that conference I met Mordechai Shani, the director and founder of the Gertner Institute. Founded in 1991, the institute serves as a national research setting for the study of epidemiology and health policy. It does extensive research on major chronic diseases and
assists in the formulation of national health policy. I was fascinated by this sort of work. As a physician, I’d been wondering for many years how to deal with the many Palestinian families afflicted by such prevalent genetic disorders as thalassemia and hermaphroditism, and congenital disorders including phocomelia and anophthalmia. The patients weren’t getting the help they needed, nor were the families, and no one was doing research in this area. I wondered if this Gertner Institute could be the place that would conduct studies on these medical anomalies.
But there were more immediate research questions to be answered, about the Palestinian patients who currently come to Israeli hospitals for treatment, for instance. Who are they? What are the numbers, ages, sexes of these patients? What ailments and diseases bring them into hospital? How big a problem is this? Research propositions were pouring into my mind even as Mordechai Shani was describing his institute. I knew right away that I wanted to work there, and I asked if I could have a meeting with him. Mordechai is a man of action and few words, and he makes decisions the same way. After I explained my interests and my background to him, he said, “Start your research immediately.” Which I did. Before the year 2007 was ended, I was on staff at the Gertner Institute at the Sheba hospital in Tel Aviv.
The contract work I’d already been doing had allowed me to travel all over the Gaza Strip and had given me an opportunity to crunch the numbers that I felt told the story of present-day Gaza and explained the sources of some of its medical problems: the unemployment, the deprivation due to the blockade, the deteriorating health, social and economic structures. It’s never been easy in Gaza, but it’s been a lot worse in the last few years. Almost everything can be measured in terms of loss. Agriculture, for example, is down to half of its usual harvest, and productivity in industry has dropped an astonishing 90 percent. There are almost no construction
materials coming into the Gaza Strip and certain medicines are banned. The Israelis have even calculated the number of calories a person needs to survive and allow only bare essentials to cross the border into the Strip. Fruits such as apricots, plums, grapes and avocados, even dairy products, are suddenly declared non-essential and forbidden to us. What’s going on here? Whose goals are these?
The stiffening embargo, the incursions, attacks and arrests are playing on the psyches of the people. What’s worse is that Gazans don’t see the outside world caring much about our plight. That adds to the angst. Our politicians bicker about who said what and who will recognize whom and then change their minds when a new slate of officials is elected. All this while babies die from malnutrition and mothers bleed to death in childbirth and an old lady with cancer is held up at the Erez Crossing because someone is trying to teach someone else a lesson.
The International Committee of the Red Cross (ICRC) has criticized the current embargo. In a November 2007 report called “Dignity Denied in the Occupied Palestinian Territories,” it said:
Palestinians face hardship in their daily lives; they are prevented from doing what makes up the daily fabric of most people’s existence. They face a deep human crisis, where millions of people are denied their human dignity. Not once in a while, but every day, and the people of Gaza are trapped and sealed off. The humanitarian cost is enormous, people can barely survive, families unable to get enough food increased by 14 percent, and Palestinians are being trampled underfoot day after day. In Gaza under siege, Palestinians continue to pay for conflict and economic containment with their health and livelihoods.
We’ve learned to do without, manage with less and cope with deprivation over and over and over again—for sixty years now. If
anyone thinks this does not have an effect on the physical and mental state of the people, that person needs to come to Gaza to check for himself. The situation is simply not tenable. And I’m not the only one to describe it this way. The ICRC confirms that “every day, 69 million litres of partially treated or completely untreated sewage—the equivalent of 28 Olympic-size swimming pools—are pumped directly into the Mediterranean because they cannot be treated.” When I was a boy, we didn’t have running water in the house. Now, fifty years later, we have access to running water, but only on certain days. Why? Because, like everything else in Gaza, the water supply system is damaged and the material needed to repair it sits on an embargo list.
Everyone in Gaza scrounges for old parts and broken concrete to patch their lives together. The water and sanitation services are on the verge of collapse. One can only imagine the size of the public health catastrophe that threatens us. This is what I mean when I tell people that Gaza could implode. Imagine if we were faced with water-borne illnesses. Imagine the chaos, the unnecessary deaths. And imagine the laying of blame: people would say, if spare parts and water pipes hadn’t been stopped at the border, no one would have died.
I have been trying to alert authorities to the consequences of a broken health care system for more than a decade. Now the Red Cross is sounding the same clarion call:
Gaza’s health-care system cannot provide the treatment that many patients suffering from serious illness require. Tragically, a number of them are not allowed to leave the Strip in time to seek health care elsewhere. Health issues in Gaza are often politicized and patients find themselves caught up in a bureaucratic maze. The procedures for requesting permission to leave the territory are complicated and involve both the Palestinian
and Israeli authorities. Seriously ill patients sometimes have to wait for months before the relevant authorities allow them to leave the Gaza Strip.
Even when patients do obtain the necessary permits to leave, the transfer through Erez Crossing into Israel can be arduous. Patients on life-support machines have to be removed from ambulances and placed on stretchers then carried 60–80 metres through the crossing to ambulances waiting on the other side. Patients who can walk unassisted may face extensive questioning before they are allowed through the crossing for medical treatment—or, as sometimes happens, before they are refused entry into Israel and turned back.
Some of the health issues have been addressed, some even solved. But every time there’s a government change on either side, the rules for transfer and treatment change. It’s a life-threatening situation that creates rage among those who endure it. Here are the facts the Red Cross reports:
They depend on a timely and reliable supply of medicines from the Palestinian Authority’s Ministry of Health in the West Bank, but the supply chain often breaks down. Co-operation between the health authorities in the West Bank and Gaza is difficult. Complex and lengthy Israeli import procedures also hamper the reliable supply of even the most basic items such as painkillers and X-ray film developers. As a result, some patients, including people suffering from cancer or kidney failure, do not always get the essential drugs they need.
For example, the ventilators for newborns at Al-Shifa hospital are out of order. It’s not possible to get spare parts to fix them. How do you explain to a mother and father that their baby will die
because the truck with the parts for the ventilator is being held at the border?
Gaza has been the centre of war so many times, it’s not surprising that the number of Gazans who have lost limbs is high. Dozens of amputees wait for treatment. Why? Does importing artificial limbs pose a security risk? Or is this about punishment? How do you explain this to a five-year-old who lost a limb when his house fell on him after it was shelled by the Israeli army, or to an angry young man who can’t get off the floor to learn to walk again?
That the Gaza hospitals are rundown and that they can’t be repaired because of an embargo is preposterous. This is a medical issue; it’s not about recruiting soldiers and making rockets. Here are the facts as reported by the ICRC:
Much of the equipment is unreliable and in need of repair. Complicated procedures for obtaining approval to import spare parts make it difficult and time-consuming to bring in and maintain hospital equipment, such as CT scanners, and spare parts—even for hospital washing machines. Daily power cuts and power fluctuations continue to damage medical equipment. Most hospitals have to rely on backup generators for several hours a day, but it is never certain that enough fuel will be available to run them.
Unemployment stands at 44 percent. Seventy percent of Gazans are officially below the poverty line with monthly incomes of less than US$250 per month for a family of seven to nine. Forty percent are classified as extremely poor with incomes of US$120 per month. Because of industry shutdowns, 70,000 jobs have disappeared. We rely a lot of the time on goods coming through the tunnels that have been dug underground into Egypt. But the
tunnels can’t begin to meet the needs of 1.5 million people. What’s more, they’re regularly bombed by the Israeli air force.
Even farming, which has always been part of the lifestyle and economy of Gaza, is in danger because of the embargo. Gaza used to export tons of fruits and vegetables to Israel, and thousands of workers as well. Not anymore—there’s no place for farmers to sell their produce. Drive around Gaza and you can see the evidence. Drainage ditches are destroyed, and so are greenhouses and water wells. Irrigation systems have been wrecked by military operations and trees have been uprooted. The ICRC examined the issue and found that many farmers “are effectively denied access to parts of their land because of the Israeli-imposed ‘no-go’ zone on the Gaza side of the border fence with Israel.”
At least 30 percent of the arable land in Gaza lies within this buffer zone, which can extend up to one kilometre from the fence. A farmer never knows for sure if it is safe to work his land or to harvest within the zone. Farmers risk being shot at when tending to their land and incursions by the army often leave fields and parts of the harvest destroyed. Getting agricultural production up and running again is difficult not only because of the destruction that has occurred, but also because Israel does not allow the importation of suitable fertilizers and because many types of seedlings are difficult or even impossible to find in Gaza.
Fishing faces the same impossible restrictions: Gaza’s boats are not allowed past the three-nautical-mile limit, which effectively cuts our fishery off from the bigger species and the sardines that made up 70 percent of the catch before the 2007 embargo was enforced. Israeli gunboats guard the perimeter, aiming their guns by day and night along the shore and onto the small boats of hapless fishermen.
In other words, Gazans are trapped. Even students I know who have received scholarships to study in the United States have been denied exit visas from Gaza. In 2008 there was a boy with a Fulbright scholarship who had to turn this huge opportunity down because he couldn’t get the permit he needed.
The International Committee of the Red Cross has appealed for the lifting of restrictions on the movements of people and goods as the first and most urgent measure to end Gaza’s isolation and allow its people to rebuild their lives. The report says:
A lasting solution requires fundamental changes in Israeli policy, such as allowing imports and exports to and from Gaza, increasing the flow of goods and people up to the level of May 2007, allowing farmers to access their land in the de-facto buffer zone and restoring fishermen’s access to deeper waters. Humanitarian action can be no substitute for the credible political steps that are needed to bring about these changes. Only an honest and courageous political process involving all States, political authorities and organized armed groups concerned can address the plight of Gaza and restore a dignified life to its people. The alternative is a further descent into misery with every passing day.
This report, from an internationally recognized organization that has a reputation for not taking sides, is of great value to both Gazans and Israelis. But I have to admit that, coupled with the information I have gathered myself in the villages and camps and cities of the Gaza Strip, the ICRC report struck a discouraging blow to the psyche of a man who has believed with all his heart that the situation can and must improve.
I find myself holding tight to the knowledge that Israeli doctors feel as I do: the humanitarian work we undertake as physicians is
a bridge across the divide; it can help untangle the distrust and promote a relationship that can lead us out of this quagmire. The director general of the Sheba Medical Center in Tel Aviv is Dr. Zeev Rotstein. He has a vision for this region that can become a reality through health care. I’ll let him explain his own views about how medical teams can reach across the divide:
I’m a cardiologist. Part of my job before the [first] intifada was the diagnosis and treatment of congenital heart disease among children, specifically in Gaza and the West Bank. My heart is with those children who can’t get the treatment they need. I used to go there once a week to evaluate them and refer them for treatment. Before the intifada the population there was much better off from a health point of view. They had full access to medical services and good follow-up in Israel free of charge, plus Gaza doctors were being trained here in Israel. But since the last intifada started—and I’m trying to avoid politics here—to my eyes, the children are the ones who are paying the full price. The training of physicians stopped. Access to medical services isn’t as smooth as it was. It’s really affected by the politics in the area. I always keep that in mind during the collaborating with our colleagues from Gaza. We’re trying to promote health and alleviate misery and disease. From the very beginning, I declared an open door for those children who are diagnosed in two specific fields. One is cancer—we can cure more than half of the cancers and 88 percent of blood cancers. The second set of diseases we can help tremendously is congenital heart disease. We can take these blue children and transform them into pink children. Without this, they die in misery, suffering complications of congenital heart disease. We can do this, we really can do it. It’s just a matter of being stubborn.
Izzeldin has a very good record of treating these cases. His mission was defined as one that would evaluate and define epidemiologically the effect a bilateral relationship had on those children. He was fighting for better medical services, better follow-up and productivity in closing the circle. He was improving the treatment by closing the loop. For example, a child can get treatment here in Israel but goes home and has no support and a lack of continuation of care. I saw Izzeldin as a kind of coordinator. By his research activity he improved results for those kids. He worked here and there collecting data. Unfortunately, the only data available to him on this side was from Tel Hashomer [Sheba hospital]. Not everyone wanted to collaborate. They made it difficult to collect medical material from them. Here our files are computerized and we’re open to this kind of activity and sympathize with it.
Izzeldin says health care can be an important bridge between two people. I agree with him. It works because saving a life and not giving up and doing that over and over again gives the other side the opportunity to see the face of Israelis, not through rifles, but through health care. People who were born and raised there come here for treatment. They don’t know us. They don’t know how sensitive we are about life. They don’t know the real Israeli. Palestinians are incited from birth. They tell us that they never imagined we were human, that they thought we were monsters, conquerors, people who wanted to see them dead. Then they’re treated by us and are surprised that those things are not true.
The majority of Israelis want to live side by side. I’m sure it’s that way with Palestinians as well. But we’re led by extremists on both sides. It’s so easy to incite the people with the misery they are in.